Ultrasound in Obstetrics & Gynecology最新文献

Objective: Portosystemic shunts in growth-restricted fetuses are more common than previously thought. We aimed to describe fetuses with growth restriction and transient oligohydramnios in which a congenital intrahepatic portosystemic shunt (CIPSS) was noted during follow-up.

Methods: This was a retrospective study of all fetuses diagnosed with growth restriction and transient oligohydramnios during a 5-year period in a large tertiary referral center. Our routine evaluation of growth-restricted fetuses includes monitoring of estimated fetal weight, assessment of biophysical profile, Doppler imaging, thorough examination of the umbilical-portal system and evaluation of cardiac function using fetal tricuspid annular plane systolic excursion (f-TAPSE). We compared these parameters before and after the resolution of the oligohydramnios using descriptive statistics and the Wilcoxon signed-rank test for paired non-parametric variables. During the surveillance of fetuses with transient oligohydramnios, we noted the appearance of a CIPSS and followed up such cases after birth.

Results: A total of 2144 women with a singleton pregnancy with suspected fetal growth restriction were referred to our center between January 2018 and December 2022. In 12 fetuses, oligohydramnios was evident upon initial assessment, and a CIPSS was diagnosed with normalization of amniotic fluid level. The median gestational age at diagnosis of growth restriction and oligohydramnios was 25 (range, 21-30) weeks. The estimated fetal weight was at the 1^st percentile in 10/12 fetuses. The median amniotic fluid index was 5 (range, 2-5) cm at the initial appointment and improved significantly to 13 (range, 11-20) cm following the shunt diagnosis (P = 0.002). Among fetuses with f-TAPSE data available, the f-TAPSE increased significantly from 4.0 (range, 3.0-5.0) mm before the diagnosis of CIPSS to 8.0 (range, 5.0-9.4) mm following the diagnosis (P = 0.043). The median gestational age at delivery was 36.3 (range, 30.8-38.4) weeks. In nine (75%) fetuses, the diagnosed shunt was left portal to left hepatic vein. Neonatal follow-up revealed spontaneous shunt resolution within 30 months in all newborns. One newborn required embolization owing to suspected shunt, however, no shunt was detected during the procedure.

Conclusions: The development of CIPSS in growth-restricted fetuses with oligohydramnios appears to improve hemodynamic status as evidenced by normalization of amniotic fluid index and increase in f-TAPSE. Evaluation of the liver portal system in fetuses with growth restriction offers an understanding of the shunt salvage phenomenon. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.

A standardized methodology for the ultrasound evaluation of the pelvic sidewall has not been proposed to date. Herein, a collaborative group of gynecologists and gynecological oncologists with extensive ultrasound experience presents a systematic methodology for the ultrasonographic evaluation of structures within the pelvic sidewall. Five categories of anatomical structures are described (muscles, vessels, lymph nodes, nerves and ureters). A step-by-step transvaginal ultrasound (or, when this is not feasible, transrectal ultrasound) approach is outlined for the evaluation of each anatomical landmark within these categories. Accurate assessment of the pelvic sidewall using a standardized approach improves the detection and diagnosis of non-gynecological pathologies that may mimic gynecological tumors, reducing the risk of unnecessary and even harmful intervention. Furthermore, it plays an important role in completing the staging of malignant gynecological conditions. Transvaginal or transrectal ultrasound therefore represents a viable alternative to magnetic resonance imaging in the preoperative evaluation of lesions affecting the pelvic sidewall, if performed by an expert sonographer. A series of videoclips showing normal and abnormal findings within each respective category illustrates how establishing a universally applicable approach for evaluating this crucial region will be helpful for assessing both benign and malignant conditions affecting the pelvic sidewall. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Objective: To determine if the resolution of fetal growth discordance after laser surgery in pregnancies with twin-to-twin transfusion syndrome (TTTS) and coexisting selective fetal growth restriction (sFGR) can be predicted by estimated fetal weight (EFW) discordance recorded prior to the development of TTTS (pre-TTTS).

Methods: This was a single-center, retrospective analysis of prospectively collected data on monochorionic twins with concurrent TTTS and sFGR that underwent laser surgery and had available growth ultrasound records from a pre-TTTS ultrasound evaluation. Maternal demographics, pregnancy characteristics and birth outcomes were compared between three outcome groups: double twin survival with resolved sFGR determined by birth weight discordance (BWD) < 20%; double twin survival with ongoing sFGR determined by BWD ≥ 20%; and single or double fetal demise after laser surgery. One-way analysis of variance or the Kruskal-Wallis test was used for continuous variables. The chi-square test or Fisher's exact test was used for categorical variables. A multivariate logistic regression model was constructed based on univariate associations.

Results: Ninety-seven patients with TTTS and concurrent sFGR underwent same- or next-day laser surgery after a TTTS staging ultrasound at a median gestational age of 19.4 (interquartile range (IQR), 18.0-22.3) weeks, with a median EFW discordance of 28.8% (IQR, 22.9-34.0%). At delivery, 34 (35.1%) patients had resolved sFGR with a median BWD of 7.7% (IQR, 3.5-13.0%), 34 (35.1%) had ongoing sFGR with a median BWD of 30.6% (IQR, 24.4-43.9%) and 29 (29.9%) had a single or double fetal demise. Although some characteristics available at the time of TTTS diagnosis, such as the donor umbilical artery end-diastolic velocity (P = 0.0087) and donor umbilical artery pulsatility index (P = 0.0061), also correlated with growth outcome, multivariate logistic regression analysis identified EFW discordance at the pre-TTTS ultrasound as the primary determinant of the odds of resolved growth discordance at birth (P = 0.0063).

Conclusions: In patients undergoing laser surgery for TTTS with coexisting sFGR, a history of concordant growth at the pre-TTTS scan prior to the development of TTTS was associated with the resolution of fetal growth discordance at birth. These findings suggest that TTTS pathophysiology can contribute to growth discordance noted at the time of TTTS diagnosis. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.